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NPI Code Detail

MEDICARE: NEXTREMITY PROSTHETIC DESIGN, LLC

MEDICARE: NEXTREMITY PROSTHETIC DESIGN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1224P00000XProsthetist

General Provider Information

NPI Number : 1861948242
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEXTREMITY PROSTHETIC DESIGN, LLC
Provider Business Mailing Address
First Line : 471 E 1000 S STE F
Second Line :
City : PLEASANT GROVE
State : UT
Zip : 84062-3694
Country : US
Telephone Number : 855-407-1227
Fax Number : 855-228-4222
Provider Business Practice Location Address
First Line : 4115 E VALLEY AUTO DR STE 202
Second Line :
City : MESA
State : AZ
Zip : 85206-4612
Country : US
Telephone Number : 800-311-5899
Fax Number : 866-710-3106
Authorized Official
Title or Position : OWNER
Name : ALICIA HERMOSILLO
Credential :
Telephone Number : 801-830-6161
Provider Enumeration Date : 08/26/2016
Last Update Date : 06/11/2024

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Directions to “NEXTREMITY PROSTHETIC DESIGN, LLC ” Practice Location

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